The concept of diffusion of innovation is that new
clinical treatments are not uniformly adapted throughout
the health system. Typically, there are centers of
innovation, early adopters of innovation, mid-term
adopters and eventually late adopters of innovation.
Some of this has to do with economics and some of it has
to do with the pace of information being transmitted
through professional channels via the literature and
meetings.

Since time is both your best friend and worst enemy, it
is imperative that caregivers be knowledgeable about
what is being developed. Often years elapse between the
first stages of research and the time of publication of
research results. Consider the history of Taxol. Today
Taxol is a first line drug for breast and ovarian
cancer. Its long and complicated history began in 1962
when the first samples of the pacific yew tree bark and
needles were collected. Twenty-two years later, in 1984,
after an enormous amount of research, it began its first
Phase I clinical trials to see if it was a useful drug.
It took another nine years, until January 1993, before
it was generally available for other than experimental
purposes. It then took another period before it found
its way out of the academic medical centers to the
corner oncologist.

It is imperative to know that it may
take several years merely to prepare an article for
professional publication, have it go through the peer
review process and then have it published. For the
proactive caregiver, knowing what is on the horizon
provides a leg up if it is necessary to go for some new
medications or procedures that are not available in your
community. For example, in my wife’s case, we had been
following the saga of Taxol and were ready to jump on it
as soon as it was released. In fact, thanks to the hard
work of Dr. Donald Higby at Baystate Medical Center in
Springfield, Massachusetts, a teaching hospital
associated with Tufts Medical School, Sandra was the
first person in Western Massachusetts to take the drug
one day after its release.

STEP #4 RECOGNIZE FEAR, ANGER AND FRUSTRATION

Anyone who has a diagnosis of cancer is fearful and
often angry. Why me? is a common question. Some people
with cancer also blame others; “If there wasn’t so much
stress in my life, I wouldn’t now be sick.” My
experiences suggest that all you can do is validate that
fear or anger. Trying to be logical or scientific does
nothing but add fuel to the fear or anger. If possible,
some type of therapy, particularly support groups for
the entire family, should be considered.

In most instances, the caregiver is
equally fearful and angry. While it is clearly useful to
share these emotions with therapists and in a caregiver
support group, one should be more circumspect in sharing
it with the victim. Frankly, they have enough on their
plate dealing with their own issues. As another friend
put it simply, “The caregiver has to be the rock, the
foundation of the family, and who needs a crumbling
foundation?”

STEP #5 FORGET STATISTICS

There is only one statistic that counts, whether you are
alive or dead! Articles and physicians like to talk of
survival rates, but these numbers are not relevant since
one’s only concern is not the cohort’s survival but
rather the individual’s survival. So even if the
five-year survival rate for ovarian cancer is 15
percent, what difference does it make if you are not one
of the survivors?